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How to achieve health coverage for nomadic pastoralists

Healthcare

How to achieve health coverage for nomadic pastoralists

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From here to those hills in the distance is an open landscape only occasionally inhabited by nomadic pastoralists. They need health services but building a hospital here isn’t a viable option. PHOTO CREDITS: Dr. J.M. NDIRITU

The argument
Conventional health care infrastructure designed for those living in permanent settlements is not a viable option for the nomadic pastoralist. This is an argument already established in Rethink Health Care Provision for Nomadic Pastoralists. Meeting their right to health care requires a novel strategy which adapts to their constant mobility rather than seeking to change it. 
Ensure Healthy Lives and promote well-being for all
Besides the UHC, Kenya has committed to the achievement of the Sustainable Development Goals (SDG). Kenya played an instrumental role in the drafting of these goals, having co-chaired the UN open working group that created the goals. The country should be in the lead when it comes to achieving goals whose creation it led. The third sustainable development goal is of critical importance here. It could difficult for the nation to ensure healthy lives for all without reaching out to the nomadic communities. They are the population with the worst indicators on all the targets of the third SDG. Sustained health care services to the nomadic pastoralists should be a priority if the nation is to improve its statistics on population health indicators.
Maturation for the counties 
This is the one area where devolved health care can leave a mark. Devolution in itself is a significant milestone toward achieving full health coverage for pastoralist communities. When we think of taking resources and services to the people, who needs it more than those in remote areas lacking basic infrastructure? Devolving healthcare in “settled counties” means building hospitals in towns and health centers in the villages and shopping centers. A similar strategy cannot work for “nomadic counties” in Kenya’s arid and semi-arid frontiers. The unpredictability and uncertainty is a nightmare from the perspective of fiscal planning. But this challenge is an invitation to a different approach to health care provision. Health care priorities, in this case, changes from fixed infrastructure to one that is attuned to the mobility of the pastoralists. The difficulties implicit in this strategy should be taken as the essential growing pains for devolution. 
Creating the “nomadic hospital”
The “nomadic counties” should get robust vehicles which can hold out against the rough terrain. Modify them to build real hospitals on wheels. Safety for the equipment and health workers is key. They will be traversing vast wilderness with wild animals, frequent dust devils and the unrelenting sun. Considering the distance and the lack of roads, they must carry extra fuel and spares parts. They must also have personal provisions of the medical crew who often may have to spend days and nights on their outreach missions. Their time away from home should not be a struggle. 
It essential to add food supplies since these communities are often in dire need of it. To form a holistic care for the communities requires catering for their livestock as well. Veterinarian services should be added to the human health agenda. This means an entire assemblage of advanced medical equipment, food, medicines, and professionals on an outreach health mission. Remember, this isn’t just some tryst strategy for cough medicine and basic care.
It conjures up the image of a health care convoy traversing Kenya’s vast arid wilderness. What a wonderful scene it would be. Picture those long military convoys crossing the deserts of Iraq or Afghanistan. A display of might on a deadly mission. Now, visualize a similar convoy crossing the arid areas of Kenya, large plumes of dust in their wake, on a mission to save lives and promote healthy living. Medics, social workers, veterinarians, etc. with vaccines, food, medicines, health training materials, and a singular purpose. That is the way to end marginalization. That’s how to achieve the dream of devolution and especially devolved healthcare. It is how to walk the talk of taking resources to the grassroots. In fact, on a more literal sense, it would be taking resources and services beyond the grassroots—all the way to places with neither grass nor roots. Is there a better way for devolution to actualize itself?
I didn’t think so either. 
Staffing
The commitment to bridge the geographical gap by adapting nomadic health care can only succeed if the communication gap is closed as well. The health workers must be able to communicate effectively with the people they are to serve. Nomadic pastoralists are suspicious of everyone and everything from outside. The vast majority can only communicate through their native language. The primary ingredient for a trusting relationship with the nomadic health workers is effective communication. For instance, it is unlikely that women from the nomadic Cushites in Marsabit county will trust any male doctor or nurse to provide reproductive health services. It is more likely they can trust female Muslim professionals and especially those from their communities. These counties need to invest in the training of their people to provide healthcare services. They should have doctors, nurses, social workers etc. who aren’t strangers to the language and cultural refrains of the people. It is also unlikely that people from other areas will be willing to withstand the challenges of life out in the open wilderness, in the heat, the dust, and all potential dangers.

Picture yourself as a doctor or a nurse on this sad little thing called ambulance. Your back hurts from the jolts of driving over rocks on non-existent roads. Sand particles from the dust devils fill your red, teary eyes. Your skin peeling off from sunburn. You are dehydrated and famished. Inside the pathetic first-aid box, ice-cubes protecting vaccines already melted away and some medicines are boiling. Acacia thorns puncture those hopeless tires on your way back home. You’ll be out in the open for the night, probably two or more. You’ll sure never be back here again. The people’s health be damned! PHOTO CREDITS: MELINA LENYARUA, Samburu County.

The challenges of traversing the untamed landscapes will be multiple. No matter how equipped the convoy is, they will often find themselves in difficulties where they need the help of the locals. Issues such as navigation and physical threats can best be overcome with the aid of those who are native to the terrain — the more trusting their relationship with the locals, the better for them. The more the pastoralists identify with the professionals, the more likely a symbiotic relationship will be fostered.
Sustainability
It is one thing to start such a programme and another to sustain it. Mobile health services are already provided by some NGOs as detailed in Rethink Health Care Provision for Nomadic PastoralistsThey need to be scaled up to provide health coverage to all communities. This can only happen with the resources of the national and county governments working in concert with the organizations that are already doing it. It is necessary that county governments take up the lead because they have a serious responsibility to their citizens. Leaving it to smaller organizations without the capacity for broader and sustained coverage is tantamount to absconding duty and violating the rights of citizens.
The capacity of the government to mobilize both funds and human resource is far greater any NGO. The programme should be rooted in specific legislation and sustained by official budgetary allocation. This would ensure both complete and sustained coverage of all currently under-served communities. It is the least that can be done if the promise of universal health coverage (UHC) will be fulfilled. UHC is a debt owed the Kenyans of the arid areas no less than the rest of us.
Data and planning 
Nomadic health services should also study the population they serve for planning and sustainability. Data should be collected on fertility rates, disease prevalence, case fatality rates, and other important health indicators. They should be able to develop information on population distribution, migration patterns, peculiar health challenges for each community, and other important demographic and environmental information. Failure can only be avoided if this becomes a serious scientific and social undertaking. Improvements and planning should be based on scientific analysis of current trends. This way, it will also contribute to health policy for other regions and the nation. In this data-driven century, Kenya’s standing in the global health arena would be bolstered because nomadic health care is a global challenge. 

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Dr. Joseph Nderitu

Dr. Joseph Nderitu is the founder and publisher of tiirahealth.com. Email: dr.jmndiritu@tiirahealth.com

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